This invention relates to surgical devices, and, in particular, to a device and method for anastomosing tubular body members such as, for example, in connection with intestinal surgery.
Several procedures are known for anastomosing severed ends of tubular body structures such as the esophagus and the small and large intestines including suturing or clamping severed ends together or using stapling instruments. U.S. Pat. Nos. 4,304,236 and 4,319,576 disclose apparatus for circular surgical stapling of hollow organs.
A procedure for colorectal anastomosis using an end-to-end anastomosis stapler is disclosed in Current Surgical Techniques, Vol. 3, No. 3, Surgical Communications, Inc., Kenilworth, N.J. (1980). The instrument used, generally similar to those disclosed in the aforementioned patents, consists of a tubular housing with a central bore through which a rod is received for reciprocation by means of manually operable handles. A staple cartridge assembly, including staple and anvil carrying portions, is mounted on the housing at the end opposite the handles and is capable of firing circular rows of staples into evertically juxtaposed bowel ends for the anastomosis. The instrument is introduced into the bowel for positioning between the severed ends to be joined, either transanally or via a proximal colostomy that will subsequently be closed. For colorectal anastomosis, the transanal route is described as being preferred to obviate the need for making and closing a separate opening on the bowel. However, it is pointed out that such requires excellent mechanical preparation of the colon and rectum including purgation colonic lavage including saline washouts.
Anastomosis buttons and clamps are disclosed in U.S. Pat. Nos. 3,771,526, 4,055,186 and 4,154,241. These devices may utilize inserter rods which are forced upwardly into the rectum through the anus to position one-half of the clamp device in the lower colon and engage the other half positioned in the upper colon to draw the two together. Flexible fluid supply or drainage tubes to protrude through the anus may also be provided.
Technical difficulties in suturing techniques and inherent disadvantages of stapling instruments in anastomosis are also overcome by the inventions described in U.S. patent applications Ser. Nos., 198,448 abandoned and 287,500, U.S. Pat. No. 4,467,804 filed Oct. 20, 1980 and July 27, 1981, respectively, assigned to the assignee of the present application. Disclosed in those applications is an anastomotic device and method for receiving the free ends of an anatomic tubular structure to be anastomosed, respectively, over a pair of ring-like members having annular connecting means which mate with each other to connect the ring-like members. When the ring-like members are secured in a fixed relationship at a predetermined distance from each other, the free ends of the tubular members are clamped contiguous to each other to enable them to grow together and approximate the outer surface of the tubular member. The anastomosis device may be formed of disintegratable material to enable disintegration in the body.
In use, the device disclosed in those applications, which will be referred to hereinafter in its embodiment for use in the intestine as a bowel anastomosis ring device, is placed between the ends of the intestine to be joined together, the ends are pulled over the respective mating ring members and tightened using a purse string suture, so as to be turned inwardly, after which the ring members are urged together until connected with the intestine ends clamped in abutting relationship there between.
The present invention provides mounting and inserting applicator means to facilitate and enable more advantageous use of the bowel anastomosis ring device as well as a method for using the applicator means resulting in an improved surgical procedure for bowel anastomosis.